This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, May 24, 2014

Weekly Overseas Health IT Links - 24th May, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Until the Food and Drug Administration provides further clarification on what types of applications would be viewed as clinical decision support, this software category will remain a regulatory gray area leaving developers unclear as to how to market these products. That is the consensus of stakeholders who met May 14 as part of a public meeting on a risk-based health IT regulatory framework proposed by federal agencies.

At Wednesday’s meeting, stakeholders discussed the possible factors used to determine whether CDS should be regulated. William Maisel from FDA's Center for Devices and Radiological Health said the draft framework that FDA, ONC and FCC released April 3 defines CDS as providing healthcare professionals and patients with “knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare.” However, stakeholders expressed their confusion regarding regulatory oversight of CDS software.

Epic to non-Epic clinical data sharing can be done, but it is not without challenges, according to a new report from research firm KLAS. The report examines what health organizations not using an Epic system have to do in order to share data with health systems that employ an Epic EHR.

Providers using non-Epic clinical systems say that while it isn't easy, they are able to share data with Epic.

Creating an anesthesia information management system is one of the challenges associated with converting paper records to electronic formats. They need to have an intuitive interface that easily fits in with anesthesiologists’ workflow, but also need to be easily integrated into an electronic medical record. Healthcare IT company Medical Information Records LLC tackled those challenges with its Anesthesia OS and has been rewarded as the winner of Dell’s Healthcare Pitch competition.

The system was developed by a couple of anesthesiologists — co-founders Dr Christopher Ray and Dr. George Armendariz.

The phone calls were part Big Brother, part benevolent parent. When a rare ice storm threatened New Orleans in January, some residents heard from a city official who had gained access to their private medical information. Kidney dialysis patients were advised to seek early treatment because clinics would be closing. Others who rely on breathing machines at home were told how to find help if the power went out.

Those warnings resulted from vast volumes of government data. For the first time, federal officials scoured Medicare health insurance claims to identify potentially vulnerable people and share their names with local public health authorities for outreach during emergencies and disaster drills.

Despite visible progress, eHealth finds it hard to get off the ground in Europe, as the latest report by the European Commission highlights. The inquiry has been led in 31 countries on a sample of nearly 9,000 doctors. According to results, the most technologically-skilled GPs are from Denmark, Norway and Spain. The least from Czech Republic, Latvia and Lithuania. Four indicators taken into account: electronic health record, health information exchange, telehealth and personal health records.

I have often been asked to distill the vast corpus of user interface design into a few key principles. While I was reluctant to do this, it turned out to be a good exercise to write “Golden Rules,” that are applicable in most interactive systems. These principles, derived from experience and refined over three decades, require validation and tuning for specific design domains. No list such as this can be complete, but even the original list from 1985, has been well received as a useful guide to students and designers. Jakob Nielsen, Jeff Johnson, and others have expanded these rules and included their variations, which enriches the discussion. Each edition of the book produces some changes. This version is from Section 2.3.4 of the Fifth edition:
Shneiderman, B. and Plaisant, C., Designing the User Interface: Strategies for Effective Human-Computer Interaction: Fifth Edition, Addison-Wesley Publ. Co., Reading, MA (2010), 606 pages. http://www.pearsonhighered.com/dtui5einfo/

Technologists have worked for years to break down data silos in healthcare. Then, just as it seemed they were starting to figure out interoperability, along comes a flood of mobile health apps that simply don't connect to anything.

A recent report from MedData Group, a market research firm based in Topsfield, Mass., found that many doctors doubt the promise of connected health, even though two-thirds use mobile apps professionally.

Only 1 percent of the 532 physicians queried this past winter thought the U.S. healthcare system would be fully connected within a year, while 57 percent indicated that it would take more than five years to get there. The doctors cited lack of interoperability more than any other barrier except issues with data security.

Electronic health records hold great promise for improving healthcare delivery and patient outcomes, but the Meaningful Use program incentivizing people to adopt EHRs has several flaws that are impeding these goals.

For instance, says Carl Bergman (pictured), a consultant who serves as managing partner of EHRSelector.com--a free service that enables providers to compare different ambulatory EHR products--interoperability should have been a primary focus for ONC and the program from Day 1.

As health information technology matures and becomes an integral part of all healthcare, more and more people will be needed who understand the field and can apply it to medicine. In an article published online this week in the Journal of the American Medical Association, two physicians--Don Detmer of the University of Virginia and Edward Shortliffe of Arizona State University--discussed the current state of clinical informatics as a board certified medical subspecialty.

Clinical informatics, Detmer and Shortliffe say, is more than simply "computers in medicine." Instead, they call clinical informatics "a body of knowledge, methods and theories that focus on the effective use of information and knowledge" to boost the quality, safety and cost-effectiveness of patient care.

Identifying high-risk clinical decision support systems is easy, but deciding how to make them safer and determining who is responsible for doing so is more difficult, attorney Brad Thompson of Epstein Becker Green told FierceHealthIT in an email.

Yesterday's focus was CDS and the potential dangers of systems that, for example, connect to automated medical devices, Thompson, who serves as general counsel for both the mHealth Regulatory Coalition and the CDS Coalition, told FierceHealthIT.

The government's Meaningful Use program mandating electronic health records is out of touch with reality. EHRs bog down process and can even worsen care.

Despite the existence of a government program called Meaningful Use, as a doctor I have yet to see a meaningful, positive impact on care from electronic health record (EHR) systems.

Regulators pushing for better and more cost effective medicine have decided that electronic technology, which has revolutionized many industries, is the solution needed to revolutionize medicine. We have been told that EHRs will make us better doctors, and they will make patients more responsible and engaged in their care. They go so far as to claim that EHRs will save doctors and hospitals time, that they will provide better coordination of care and save lives. While I can envision a world where this could be true, those of us living in the real world struggle with the disconnect between what is touted and what we experience every day.

I am disturbed by the current starry-eyed love affair with technology in health care. This blind faith in computers over physicians is destined to have tragic outcomes in the rare cases when machines cannot replace a face to face encounter with a living, breathing physician.

The "Future of Health Care" discussions making viral pronouncements like, "80 percent of what doctors do can be replaced by computer algorithms and cell phone apps" are misguided and dangerous. Here's why ...

The most important -- and often life-saving -- clinical decisions are made by physicians who are doing things that cannot be replaced by an algorithm.

Warning that many physicians will not be able to advance to Stage 3 of the electronic health records meaningful use program, the American Medical Association is suggesting radical changes to all three stages.

Absent significant changes, more physicians--already struggling with the first two stages--will drop out of the program or be unable to move to Stage 3, the association contends in a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner and National Coordinator for Health IT Karen DeSalvo, M.D.

It's no easy feat to be the best, even in the healthcare IT space, but one EHR vendor has come out on top, earning the highest scores for client experience and customer satisfaction in the small practice category.

According to a 2014 Black Book Rankings electronic health record system survey, the Irvine, Calif.-based Kareo Inc. came out as the winner for EHR and billing software systems. This marks the second year Kareo earned this distinction in Black Book Ratings.

More than 20,000 providers across the country use Kareo, according to company officials.

Implementing telemedicine monitoring in eight ICUs brought no significant decline in mortality rates or length of stay, according to astudy published at JAMA Internal Medicine.

The research compared pre- and post-implementation rates as well as those from control ICUs that did not implement an eICU program. Seven for the participating hospitals were part of the Veterans Affairs healthcare system. The comparison involved nearly 7,000 patients with similar demographics and illnesses.

It found little difference in ICU, in-hospital, or 30-day mortality rates or length of stay.

Recognizing that licensing and regulation has not kept pace with the growth of telemedicine applications, a new report offers five recommendations for the successful adoption of telehealth. The recommendations, made by the Information Technology and Innovation Foundation, a District of Columbia-based think tank, include:

Adoption of a standard definition for telehealth: While a recently published study found there to be seven different federal definitions of telehealth, the report's authors stress that H.R. 3750, the Telehealth Modernization Act of 2013, can remedy that "by defining telehealth to include healthcare delivered by real-time video, secure chat, secure email or telephone." To be successful, however, the authors say it may be necessary for Congress to "impose penalties on the non-adopting states" if they do not adopt such standards within a two-year period.

The Rise of Electronic Health Records Helps Doctors Make a Better Diagnosis

ByAmy Dockser Marcus

May 12, 2014 7:13 p.m. ET

Researchers are analyzing pools of patient information collected from routine checkups to help doctors better diagnose their patients.

This type of data is easier to mine thanks to the rise in electronic health records that contain information collected in regular doctor visits.

In one instance, a group of researchers looked at data from patients with sore throats and came up with a way to help determine whether people should see a doctor for a strep throat test or stay home and take aspirin. In another, a pediatrician was able to follow a hunch to study a connection between an eye disease and allergies in young patients with arthritis.

The quantity of data that is collected during routine medical visits is huge. It can include everything from X-rays and blood tests to doctors' written observations.

The Pentagon is readying an $11 billion contract to overhaul its electronic health records system, the biggest federal IT job since last fall’s HealthCare.gov debacle and one that will test the administration’s procurement finesse.

DOD will issue a final request for proposals late this summer for the project aimed at arming military medicine with state-of-the-art records.

The system covers nearly 10 million active duty and retired members of the armed services and their dependents. Its sheer size and history of troubled reforms have led skeptics to pay close attention and express concern that it could become another failed megatech contract.

No health IT system or solution can stand alone; for an innovation to be truly useful in a modern clinical or medical environment it must be able to connect to enterprise systems such as electronic health record systems, hospital information systems, practice management systems or numerous other "legacy" environments. On Wednesday, May 14, I will be in Brooklyn, N.Y., at HxRefactored presenting a deep, practical and actionable lecture about what the challenges are to legacy systems integration and how to overcome them without going into the full-time services business. This Perspective is a preview of that presentation.

The need for and attention to interoperability in health care is palpable -- more and more vendors talk about, and even more customers complain about, how it's missing from products. Service vendors are struggling to make it happen and even the government is joining the chorus to help. However, interoperability is too grand a vision in a fragmented and enormous industry the size of health care. What we need to focus more on is basic blocking and tackling around systems integration, not the nirvana of full interoperability.

John Halamka, M.D. predicted on May 13 that 80 percent of U.S. hospitals would fail to attest to MU Stage 2 on time

John Halamka, M.D., the CIO of Beth Israel Deaconess Hospital in Boston, has never shied away from speaking out on issues he has an interest in, nor from controversy. And in his keynote address at the Boston Health IT Summit, sponsored by the Institute for Health Technology Transformation, or iHT2 (which since December 2013 has been in partnership with Healthcare Informatics through its parent company, the Vendome Group LLC), Dr. Halamka was blunt and straightforward in his comments on Tuesday morning, May 13.

Nearly all states collect hospital discharge data with 33 states selling or sharing de-identified information--not covered under HIPAA.

That raises concerns that the hospitals are turning over data potentially vulnerable to re-identification, according to the Federal Trade Commission.

De-identified information is generally defined under the HIPAA Privacy Rule as information that does not identify an individual and for which there is no reasonable basis to believe an individual can be identified from it. "If you've had a hospital visit, and in most states a physician visit, information about your visit is in discharge data," according to Latanya Sweeney, chief technologist at the FTC. "It doesn't have names, addresses, or Social Security numbers. But, it includes diagnosis codes, procedure codes, and how you paid for it."

The face of telehealth is changing in ways that are becoming unrecognizable from just a few short years ago. No longer is it just a rudimentary communication between healthcare providers and patients. It is now a substantive encounter that reflects the intimacy and personal nature of a face-to-face visit, providers of new-generation technology say.

As technological advancements focus on the integrity and dimension of quality patient care, it is giving rise to a new term that is being used more often in the field by people like Kevin Fickenscher, MD, chief medical officer of AMC Healthcare: Telecare.

“I describe us as being in the telecare business,” he said. “Telecare is much more proactive than telehealth.”

A majority of patients who received neurologic follow-up care via video telehealth technologies were "highly satisfied" with the results, according to new research published this month in Telemedicine and e-Health.

The study looked at 354 consecutive patient visits over a two-year period in rural areas of New Mexico, southern Colorado, eastern Arizona and western Texas. Of those involved, 87 percent evaluated the approach as improving satisfaction; 90 percent of the patients reported they were "fully satisfied."

Kaiser Permanente and its partners will expand their efforts to provide a learning health system through patient-centered outcomes research focused on cancer, obesity and heart diseases.

The project will focus on data standards, incorporating patient-reported data more systematically, implementing multisite data governance procedures and integrating the PCORnet PopMedNet platform across the partners' research centers.

The Oakland, California nonprofit received a $7 million grant for The Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) project, one of 29 clinical data research networks that received funding from the Patient-Centered Outcomes Research Institute (PCORI).

Almost 50 percent of hospitals with 200 or more beds will purchase a new electronic medical record system by 2016, according to a KLAS report.

Several factors are driving these hospitals' decisions to invest a significant amount of capital into a new EMR system, including the following.

1. Many organizations' first EMR system was bought quickly under meaningful use deadlines and no longer meets their needs. When the meaningful use program began in 2011, many hospitals rushed out to purchase an EMR system that would fulfill stage 1 requirements. However, many of these systems have proved to not have necessary functionality either for stage 2 or hospitals' day-to-day workflows, or have been acquired or gone out of business, according to an article in InformationWeek.

According to new market research report from Research and Markets, healthcare business intelligence (BI) Market, estimated at about $2.4 million in 2013, is expected to reach more than $4.7 million by 2018, growing at a compound annual growth rate of 14.8 percent over the period.

Healthcare practices find partnering with a cloud service provider for their electronic health records lets them focus on their patients, not on IT.

Cloud-based electronic health records are gaining popularity, especially among small and midsized practices without large internal IT departments.

IT staffing is an issue for many healthcare organizations. It's challenging to find someone -- never mind an entire team -- adept at keeping up with regulatory and compliance issues, security, and other requirements while simultaneously meeting day-to-day business needs. Placing that onus on a better equipped, healthcare-focused partner removes a financial and personnel problem, allowing providers to focus on their practices, many healthcare executives say.

Scott Mace, for HealthLeaders Media , May 13, 2014

HIT leader and now author, Jonathan Bush, doesn't mince words. Hospital chiefs are almost all "facing in exactly the wrong direction," he says, when they should be in "assault mode" against "that which is bigger and more sclerotic" than themselves.

It's National Hospital Week, and while many hospital and health system leaders and staff may be celebrating, healthcare IT leader and presidential cousin Jonathan Bush is lobbing a bombshell of a new book into the lobby.

"Where Does It Hurt? An Entrepreneur's Guide to Fixing Health Care" rolls hits the street Thursday, May 15. I will have a full review next week, but this week, the CEO and co-founder of the ambulatory EHR software maker Athenahealth tells me why he co-wrote the book, and why hospitals as we know them, due to technology and other factors, are as endangered as the traditional department store. This is an edited transcript of my conversation with Bush.

A Health IT Policy Committee workgroup on May 8 recommended major changes to the electronic health records certification program, one day after getting stakeholder feedback during a contentious public hearing.

Paul Tang, M.D., the HIT Policy Committee vice chair who led the Certification Hearing Workgroup, called the recommendations a "massive change" to the current certification program. One recommendation is to take a “holistic” and “end-to-end" approach to the process of certification, starting with meaningful use objectives through the definition of testing to auditing at the end of the process. The workgroup's second recommendation is to limit the "scope" of the HIT Certification Program to three areas: interoperability, clinical quality measures, and privacy and security.

"To summarize, we have two major conclusions. They're made up of many component parts but they're all based on what we heard yesterday," he told the workgroup at the end of its three-hour discussion on May 8. Tang argued that the goal is to create a "more streamlined, more coordinated, and more timely process, as well as have ongoing feedback so that it can be continuously improved--at least in the regulatory environment."

An analysis of 9,400 patients transferred from an acute care hospital to an inpatient rehabilitation facility revealed that a standard test of functional abilities was a good predictor of which patients might need to be readmitted to the hospital within 30 days.

“The Functional Independence Measure score is a direct reflection of a patient’s ability to heal,” said Erik Hoyer, M.D., of the Johns Hopkins University School of Medicine. “When a person cannot move his or her legs or use the bathroom independently, for example, it’s telling us something about the body’s physiologic reserve, its overall ability to be resilient to disease.”

All inpatient physical rehab facilities in the United States already require use of the standard Functional Independence Measure (FIM) to assess inpatients’ physical capacity for a wide range of tasks, including the ability to transfer themselves between a chair and a wheelchair, the toilet or the shower; to walk, eat, bathe and dress on their own, as well as to effectively communicate, socially interact, solve problems and remember important information. The FIM must be conducted within 72 hours of admission to a rehab facility, and the scores are reported to state and national agencies.

Though the healthcare industry in general isn’t lacking in available online resources to aid data breach management, organizations may want to check out the American Health Information Management Association’s (AHIMA) recently published Breach Management Toolkit.

The tool requires an AHIMA membership, but the Journal of AHIMA detailed what the tool has to offer providers and a sample of required elements within a data breach notification letter.

After a lengthy and often colorful hearing with providers, vendors and other stakeholders on the merits and drawbacks of the Office of the National Coordinator for Health IT’s certification program, the Health IT Policy Committee’s Adoption & Certification Workgroup formally endorsed narrowing certification requirements to interoperability, clinical quality measures and privacy and security, and embarking on an end-to-end, holistic, rapid improvement process to improve certification.

eHealth must foster inclusion and solidarity

17/05/2014 16:45

The FINANCIAL -- Coinciding with the opening of the 2014 eHealth forum in Athens held under the Greek Presidency, EPHA highlights the necessity that eHealth solutions must meet the needs of all end users including individuals with specific health conditions and their carers, vulnerable groups, and health providers, according to EUbusiness Ltd.

The rapid growth of mHealth, which includes smartphone apps and other tools, such as sensors and robots enabling remote monitoring, ambient assisted living and real-time communication between and amongst patients and health professionals, is bringing eHealth closer to end users and narrowing the digital divide. However, as the recent report on 'Health inequalities and eHealth' by the eHealth Stakeholder Group points out, everybody approaches technology in a different way and there are still many barriers related to the effective use of eHealth beyond the initial hurdles of access and affordability, according to EUbusiness Ltd.

Given the ongoing economic crisis in many parts of Europe, EPHA calls for effective integration of eHealth into European health systems to avoid further amplification of health inequalities. eHealth can contribute to improving access and building solidarity in Europe but this depends on policy coherence within and beyond the health sector in order to 'Include Everybody', as recommended in the eHealth Task Force Report.

"eHealth has the potential to improve access to healthcare for all people in Europe, contributing to the promotion of EU-wide solidarity. However, this hinges upon political commitment to tackle inequalities head on. In order for individuals to exploit eHealth solutions in a meaningful way, the acknowledgement that everybody is different is important. We need to see more targeted solutions for all those who may not have the ability to use ICT proficiently, be it as a result of physical, mental, or learning disabilities, or owing to cultural, gender or other reasons. Developing digital health literacy is a complex process that involves several different competences applied simultaneously. It is one thing to know how to use technology but another to make good health decisions based on the information available online," said Peggy Maguire, EPHA President.

The issue of health inequalities has received increased attention at European level and it must also be extended to the eHealth debate. "EPHA supports the implementation of the European Commission's eHealth Action Plan 2012-2020 and of the Digital Agenda for Europe. It is important to find new ways to achieve cost containment and patient empowerment in Europe. But without strong investments in targeted education and training it will be difficult to create the level of trust and engagement envisaged by policy-makers," said Emma Woodford, EPHA Interim Secretary General.

Sharing is typically a good thing, but in the IT world it also introduces the risk of data loss.

So it shouldn't be surprising that accountable care organizations -- groups founded on the premise that exchanging data among providers will improve patient care -- are viewed as potentially vulnerable.

A study conducted by Ponemon Institute, a privacy and data protection research center, found that two-thirds of the health care organizations that are part of an ACO said the risks to patient privacy and security have increased "due to the exchange of patient health information among participants."

Choose and Book outpatient appointments system set to be replaced by a potentially more expensive e-referral scheme

·Toby Helm and Denis Campbell

·The Observer, Sunday 11 May 2014 06.53 AEST

The NHS is quietly ditching an electronic booking system for outpatient appointments, Choose and Book, which has cost £356m since 2004, in a further sign of the difficulties of introducing efficient IT systems into the health service.

The decision to replace it with a potentially even more expensive e-referral scheme by 2016 follows a drop in its use by doctors and patients.

During a recent investigation into NHS waiting times by the House of Commons' public accounts committee, MPs were told by NHS staff that while some GPs liked Choose and Book, many did not, and that not all outpatient appointment slots were available on it, limiting its usefulness.